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6 Main Criteria for Selection of Metrics Metrics measure success of the Triple Aim Address populations and needs prevalent in Medicaid – Children – Behavioral health – Long Term Services & Supports – Chronic conditions Maximize alignment of metrics with currently reported metrics in the State and nationally (Medicare ACOs, Health Homes, PTE, IHOC, etc) to the extent feasible and appropriate Minimize reporting burden to providers, to extent feasible – Keep number of metrics to a reasonable number – Preference for claims-based measures – Phase in of pay for performance for non claims-based measures

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8 Minimize reporting burden to providers 22 of 26 measures are claims-based 2 HbA1c Clinical measures will be reported through HealthInfoNet: Reporting only in Year 1 1 EHR measure will be reported by State using Meaningful Use reporting data 1 Patient Experience measure will be reported by providers through national database: Reporting only on full population

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9 Quality Domain: Patient Experience Alignment with Maine Quality Forum Patient Experience Matters Initiative Hope to achieve funding for 2014 survey administration; 2015 reporting through central national CAHPS database Phase-in: Reporting only in Years 1-3 All payer populations Intent to focus on Medicaid population only in Year 3 CG CAHPS is not a requirement for participation in Accountable Communities, but is required to achieve full quality score. Percent of Total Score Core PerformanceElective Performance Monitoring & Evaluation Only 10%1.Clinician Group CAHPS

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13 Quality Domain: At-Risk Populations (Cont.) Change from Initial Proposal: Behavioral Health measures changed to this domain from Care Coordination/ Patient Safety Addition of Glucose Control (HbA1c) clinical measures – CMS required one clinical outcome “stretch” measure – Will be collected through HealthInfoNet (HIN) lab data » HIN will leverage result information it is sending providers – Reporting Only in Year 1 (lab results must be sent to HIN during performance year) – Years 2 & 3 scored on performance HbA1c testing for children changed to Monitoring from Elective

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14 Benchmark Sources Use of national Medicaid data wherever available. Where not available, DHHS will utilize: – MaineCare Health Homes and PCCM data – National Medicare data – Maine EHR Meaningful Use incentive program data Should a national Medicaid benchmark become available, the Department will begin use of that benchmark in the next performance year after it becomes available.

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15 Minimum Attainment Level Minimum attainment level (MAL) of 30th percentile to receive score on individual measure AC is Eligible for shared savings payment if it meets MAL on at least one measure in each of three pay for performance domains (Patient Experience excluded) MAL on <70% of measures in a domain  Warning and/or corrective action plan.  Failure to meet the standard may result in termination and disqualification from shared savings.

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18 Sample Size Minimum sample size of 100 MaineCare members to enable scoring on performance on a measure If there are no score-able measures in one domain, weighting will be equally distributed across remaining domains Selection of Elective measures should take into account likely sample size